An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study

Background Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.

Beyond the Statement

The purpose of this chapter is to share the experiences, motivations, and reflections of the authors' efforts of establishing an antiracism institute at a predominantly white STEM university in a small, rural county in Northern New York. To accompany their perspectives, the authors interviewed faculty members involved in this process to identify their motivations and hopes for the institute, along with the challenges and difficulties. This chapter traces the trajectory, motivations, expectations, and challenges of establishing an antiracism institute in a predominately white STEM institution.

Evaluating Local Attractiveness for Tourism and Recreation—A Case Study of the Communes in Brzeski County, Poland

For many regions and communes, the development of tourism offers opportunities for economic revival, the stimulation of local entrepreneurship and, as a result, increased budget revenues. Before such objectives can be successfully pursued, however, it is necessary to carefully consider to what degree the conditions present in a particular area are conducive to the development of tourism there, including its tourism resources and the existing state of development. This study analyzes the attractiveness of the seven communes making up Brzeski County (Lesser Poland Voivodeship, Poland) for tourism and recreation. The potential of the communes in this largely rural county was characterized using Gołembski’s index, based on multivariate comparative analysis, assessing the natural and man-made features and the degree of development of each of the communes. This analysis was further complemented using Wejchert’s impression curve, assessing visual attractiveness along selected routes in two of the communes. Of the seven communes analyzed, the Commune of Brzesko was found to have the most extensively developed services, hotel and food-service infrastructure, to be home to many historic buildings and to have a relatively high municipal budget. The Commune of Iwkowa, in turn, which scored lowest in terms of Gołembski’s index (mainly due to its underdeveloped infrastructure, few historic buildings and the fact that it is crossed by a major transit route), was nevertheless found to score significantly higher than Brzesko in terms of Wejchert’s impression curve. These findings confirm that the beauty of the landscape is not always well correlated with tourism development potential. We conclude that such a combination of methods should to be applied to reliably and comprehensively evaluate the relative attractiveness of different parts of a given region for tourism and recreation, for instance so as to inform planning decisions and the allocation of funding.

Comparing MRI and CT machine accessibility among urban and rural county hospitals

Background: In 2019, Navigant Healthcare published research showing that 1 in 5 rural hospitals in Minnesota are at risk of closing as they are not financially sustainable. With 26.7% of Minnesota’s population being rural, this is particularly worrisome. A substantial cost to rural hospitals is affording the installation, maintenance and operation of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) machines. In light of the serious pressures on rural hospitals, the aim of this paper is to investigate if a disparity exists in MRI and CT machine accessibility among Minnesota’s urban and rural county hospitals.Design and Methods: Hospitals of Minnesota were contacted and asked how many MRI and CT machines they carried at their facility. This information was compiled in an excel sheet and cross referenced to the county it resided along with the counties: population, rural-urban commuting area (RUCA) classification and land area in square mileage.Results: It was found that the state of Minnesota compared well to the national average in terms of persons and square mileage per MRI and CT machine. When comparing counties of Minnesota by their RUCA classification, a disparity is found in rural counties with regards to square mileage per CT and MRI machine.Conclusions: With distance for service creating a barrier to accessibility, rural county residents would benefit from more in-hospital MRI and CT machines. With these findings, it is pertinent further research is conducted to investigate the potential vulnerability of other rural populations with regards to accessibility to radiologic resources.

Assessment of Mycotoxin Exposure in a Rural County of Chile by Urinary Biomarker Determination

Aflatoxin B1 (AFB1), ochratoxin A (OTA), zearalenone (ZEN), and deoxynivalenol (DON) are frequent mycotoxins that may cause carcinogenic, mutagenic, estrogenic, or gastrointestinal effects. The aim of this study was to assess the exposure to and risk from AFB1, OTA, ZEN, and DON in 172 participants of the Maule Cohort (MAUCO) by a biomarker analysis in urine and to associate their exposure with food consumption and occupation. Mycotoxins in the first morning urine were analyzed by solid-phase extraction and quantified by Ultra-High-Performance Liquid Chromatography with a mass–mass detector. Participants’ information regarding food consumption, occupation, and other characteristics was obtained from a baseline and 2-year follow-up survey of the cohort. The prevalence and mean levels of mycotoxins in the urine were as follows: DON 63%, 60.7 (±78.7) ng/mL; AFB1 8%, 0.3 (±0.3) ng/mL; α-zearalenol (α-ZEL) 4.1%, 41.8 (±115) ng/mL; β-ZEL 3.5%, 17.4 (±16.1) ng/mL; AFM1 2%, 1.8 (±1.0) ng/mL; OTA 0.6% (1/172), 1.3 ng/mL; and ZEN 0.6%, 1.1 ng/mL. These results were translated into exposures of DON, ZEN, and aflatoxins of public health concern. Participants who consumed coffee and pepper the day before had a significantly greater presence of DON (OR: 2.3, CI95 1.17–4.96) and total ZEL (OR: 14.7, CI95 3.1–81.0), respectively, in their urine. Additionally, we observed associations between the habitual consumption of beer and DON (OR: 2.89, CI95 1.39–6.42). Regarding the levels of mycotoxins and the amount of food consumed, we found correlations between DON and nuts (p = 0.003), total ZEL and cereals (p = 0.01), and aflatoxins with capsicum powder (p = 0.03) and walnuts (p = 0.03). Occupation did not show an association with the presence of mycotoxins in urine.

Diet and Food Insecurity Among Residents of a Rural County

Objectives Rural residents are more likely to experience food insecurity and the related risks for obesity than urban residents. The objective of this study was to explore the association between dietary intake and food insecurity in a sample of residents of a rural county in Tennessee. Methods We used data from an obesity prevention program in a rural county in Tennessee. Adults were recruited to complete a survey, via telephone or online, about lifestyle behaviors. Dietary data were collected using the 26-item National Cancer Institute (NCI) food frequency questionnaire (FFQ). Household food security was assessed using the USDA six-item Short Form Food Security Survey Module. Respondents were classified as ‘food secure’ or ‘food insecure’. We used multiple regression models to assess the association between dietary intake (dependent variable) and food security (independent variable) in men and women separately. Models were controlled for age, race, and body mass index. Results Data from 448 surveys were included in the analysis. The respondents’ mean ± SD age was 55 ± 18 years, 60% were female, and 66% were White. Overall, the average daily intake was less than 2 cups equivalents for vegetables (1.54 ± 0.43), less than 1 cup equivalents for fruits (0.92 ± 0.40), and more than 15 teaspoons equivalents for added sugars (16.06 ± 6.36). In multiple regression models, household food insecurity was associated with lower intake of vegetables both in men (mean ± SE, secure vs. insecure 1.76 ± 0.05 vs. 1.57 ± 0.07, P = 0.02) and in women (1.42 ± 0.03 vs. 1.30 ± 0.04, P = 0.01). Household food insecurity was associated with higher intake of added sugars in women (16.74 ± 0.56 vs. 14.87 ± 0.43, P = 0.009), but not in men. Conclusions Food insecurity was a predictor of lower intake of fruits and vegetables among men and women, and higher intake of added sugars among women. These findings highlight the need to address food insecurity in rural areas by improving access to nutritious food. Funding Sources Centers for Disease Control and Prevent (CDC).

Disease and disaster: Navigating food insecurity in a community affected by crises during COVID-19

This exploratory study examines how a community experiencing food insecurity while navigating multiple crises can be a model to inform resources, processes, and systems supporting communities facing similar circumstances. Data for this study were collected from residents of a community in Oconee County, a rural county in the northwest corner of South Carolina experiencing pervasive food insecurity. The community was severely impacted by the onset of COVID-19 and further devastated by a tornado in mid-April. The area of the county that sustained the greatest damage from the tornado was the Utica Mill Hill community, home to the county’s most vulnerable population. This cascading series of events constituted a crisis-within-a-crisis for the community. In this study, we sought to learn more about community members’ experiences and the effects of the crises on com­munity members’ access to food. We conducted in-depth interviews with 14 residents living in the Utica Mill Hill community. The results provided insight into community members’ experiences of the crises and the nature of community-level response and recovery efforts. We learned about participants’ experiences with food insecurity, new food policy developments, and gained unexpected insight into community members’ experiences with mental health challenges related to the crises.

Local Response to Forced Adaptation Challenges: Lessons from a Post-flooding School Rebuilding Controversy

This study focuses on school rebuilding experiences in a distressed rural county in the wake of severe flooding. While considering scholarly literature, and making use of relevant public records and media coverage, the centerpiece of this qualitative study is an analysis of 391 public comments made in response to proposed rebuilding plans. The study focuses on how the schools rebuilding debate was socially constructed in response to the flood and in a time of growing awareness of climate change. The findings suggest that the debate was framed along lines familiar to rural school closure and consolidation controversies in general and in context of underlying political and social conditions specific to the county. Themes of power and powerlessness, fairness and justice, and community identity and viability were predominant. Specific discussion of climate change and associated themes was notably absent in the public comments. The findings suggest that existing sociopolitical context and policy domains may shape the consideration of new adaptation choices, whether forced by immediate events such as a natural disaster, or influenced by longer term concerns relating to climate change.